Emergency exemptions OK’d for federal moratorium on Medicaid waivers

ANCHORAGE, Alaska - Alaskans in emergency situations may now apply for home‑ and community-based care through the state's Medicaid waiver programs.

On June 26, 2009, the federal Centers for Medicare and Medicaid Services (CMS) placed a temporary hold on new applications to the waiver programs, which serve Alaskans with serious health needs who would otherwise require care in a hospital, nursing home or other facility.

The moratorium gives the state a window to reduce a backlog of required annual needs re-evaluations, known as re-assessments, and improve administrative procedures for its Medicaid-funded home‑ and community-based services.

CMS has now granted the state Department of Health and Social Services' request to allow an exception for emergency cases. The moratorium remains in effect for non-emergency applications to the waiver programs.

"We're deeply relieved to be able to connect these Alaskans with the services they need," said Bill Hogan, Commissioner of the Department of Health and Social Services. "We are acutely aware that Alaskans who are not in an emergency situation are still very vulnerable, and we are working diligently with CMS to guarantee the rigorous safety standards necessary for this level of care and to lift the moratorium completely as quickly as possible."

The moratorium does not affect Alaskans already receiving services. The moratorium only applies to Medicaid waivers, not Medicaid overall in Alaska.

The emergency exemption applies to Alaskans in the following circumstances:

1. terminal diagnosis of six months or less; 2. death of the primary caregiver within the previous 90 days; 3. emergency absence of the primary caregiver; 4. anticipated discharge from an acute care facility within 7 days; and 5. Adult Protective Services or Office of Children's Services referral with an intake within the previous 30 days and documentation that the applicant is not at risk for harm, based on current information, by remaining in the home with support services provided through the waiver programs.

The emergency exemption is the second part of the moratorium to be lifted.

The temporary hold on new applications initially also applied to Personal Care Assistance services, but that restriction was lifted on Aug. 12. The services are for Alaskans who need help with basic daily living skills such as bathing and dressing. The state Division of Senior and Disabilities Services started processing new applications again after federal officials reviewed and approved how the services are run.

Senior and Disabilities Services Director Rebecca Hilgendorf said the division has made swift progress to address CMS' remaining concerns and make long-term improvements.

"We have hired seven new assessors, recruited more short-term help, and have completed more than 500 re-assessments since the moratorium started," Hilgendorf noted. "We are working closely with CMS on an improvement plan that will bring the nation's best practices in this field to Alaska."

An overall corrective action plan is due to CMS by Sept. 3. CMS and the department will then collaborate on approval of the plan, a process that could take months.

The state has made progress on several CMS concerns by hiring new staff; updating provider training and offering it online; and adopting electronic assessment tools to increase efficiency and reduce the chance of errors.